This form/waiver, signed below by the parent or guardian of the child named herein, must be presented to the team manager in order for the child to be able to participate in any Ottawa Internationals Soccer Club event, including practices. Please return a signed copy to your team manager and retain one copy for your own records.

Site and team: _______________________________________________________________________

Coach: _____________________________________________________________________________
Our coaches need to be aware of any health issues that may affect your child’s ability to fully participate. Please confirm that your child has no health problems or indicate his or her health problems as requested below.

My child has no health problems ____ OR 

My child has: Asthma ______________ Wears glasses __________ Wears contact lenses ___________
Diabetes ______________  Heart condition __________ Learning disability ____________________________
Allergies (please specify) ___ Puffer required

Player’s Name: _____________________________________________________________________________________

Gender: _______ Date of Birth: Day _______ month________________ year ____________

Address: ___________________________________________________________________________________________

Telephone Number: ____________________ Email address: __________________________________________

Name of parent(s) or legal guardian: ____________________________________________________________________

Parent’s daytime telephone number(s): __________________________________________________________________

Player’s health card number (optional): __________________________________________________________________

Emergency contact name and telephone number (in case parents/guardian cannot be reached):

__________________________________________________________________________________________________

Name and telephone number of player’s doctor: __________________________________________________________

Please understand that we have your child’s safety as our prime concern and that you may be requested to provide a doctor’s certificate testifying that your child’s health will not be endangered by participating in the sport of soccer. This would normally be required in cases where a player is returning from a serious accident or injury.

I have read this consent form/waiver and understand the risks associated with the game of soccer and permit the aforementioned child to fully participate in Ottawa Internationals Soccer Club Inc. DSP programs and events. I, the undersigned, as a parent/guardian of the above-named player, hereby give my approval for him/her to play soccer. I agree to assume all risks and responsibilities incidental to such participation, including transportation to and form such activities and on behalf of the said player and myself as parent/guardian. I do hereby waive, release, absolve, indemnify and agree to hold harmless the Ottawa Internationals Soccer Club, the organizers, convenors, coaches and the participants in all activities of said Club and League, including those persons transporting the said player to and from such activities. I also agree to abide by the Published Rules of the Ontario Soccer Association, the District Association, and the Ottawa Soccer Internationals Soccer Club Inc.

Parent or Guardian name and signature: _________________________________________Date _________________

This form will be held by the team and destroyed at the end of the season.
Bob Monaghan, Vice-president DSP, Ottawa Soccer Internationals Soccer Club